Sunscreen By Mark B. Levin, M.D. The Pediatric Group, P.A., Princeton

After a brief or non-existent winter which made us stay indoors without true justification (snow), the nice weather is finally here! We will be going out in droves to enjoy nature. And we all need some sun exposure. Ultraviolet (UV) light enhances our vitamin D production to allow calcium absorption from our foods and deposition in our bones. However, while the sun is fun, there are risks, too. If we take appropriate precautions, the warm months can be relaxing and healthy.

The long term consequences (skin cancer) of unprotected skin sun exposure have now been well documented. Excessive exposure in the form of a blistering sunburn, especially occurring between 15 and 20 years of age, is the most potent predisposing factor. However, chronic unprotected low level exposure to UV radiation is also a risk factor. The best way tp prevent the effects of sun exposure (other than avoiding the sun!) is to apply sunscreen. Sunscreen is FDA-approved for anyone over 6 months of age. Since no testing has been done in children under 6 months old, it is unknown if any of the compounds used as sunscreens are absorbed through the skin of infants that young. These children have no recourse but to be shaded and limited with respect to sun exposure. Children over 6 months should have sunscreen applied sparingly to the hands and rubbed in (they put their hands in their mouth). Heavier applications are advisable from the wrists up and elsewhere on the body.

When using sunscreen, don't forget to apply it behind the knees, to the tops of feet, under the chin and behind the ears. Reflected sun from sand, water and sidewalks can cause burns in unanticipated areas. As well, children often spend their time in odd positions that expose body parts to the sun that adults would never consider exposable! Even teens, especially after school sports participants, are vulnerable. (Try to convince them, even though your efforts may be fruitless!) Keep sunscreen in convenient places as reminders for family members--in gym bags, near the door most commonly used to exit the house, in diaper bags, in the glove compartment of the car (be careful, this can get hot), etc. As with adults, children should have sunscreen applied at least one-half hour before going outside.

Parents often ask what SPF (Sun Protection Factor) to use. Use at least an SPF of 15. Children with a fairer complexion are at greater risk for the adverse effects of sun exposure, so they should use a higher SPF. The ingredients in sunscreens that block UV radiation deteriorate over time. The friction children encounter with their activity and toweling after swimming can decrease the effectiveness of sunscreens. The longer lasting waterproof varieties sunscreens should be re- applied often (about every 2-4 hours), especially in an open environment, like the shore. It stands to reason that, since most parents forget to re-apply sunscreen at regular intervals, use of a higher number SPF may offer better (longer) protection.

The totally opaque ointment, zinc oxide, is used most often in situations where sun damage can be more severe due to repeated exposure . A lifeguard's nose or newly healed chicken pox are common examples. This preparation is available over-the-counter in any pharmacy and in many supermarkets.

One of the few possible side effects of sunscreens is a rash from the SPF chemicals. If your child has sensitive skin, you would be well advised to use a lower number (though not below 15) and re-apply it regularly. The protection of longer, light-weight clothing and a hat is advisable, as well. Waterproof sunscreens tend to be gentler on the skin. Use one labeled "hypoallergenic". These are usually PABA (para-amino-benzoic acid)-free, colorless and odorless and offer the best chance of avoiding itchy rashes. A child can develop a skin rash from any ingredient, although PABA is the most common. Sensitivity to one compound does not necessarily indicate a sensitivity to the others. Read the ingredients on the label to pick the right suncreen for your child.

A child who is sensitive to a topical preparation will generally break out wherever the preparation is applied. Other children who are not sensitive may develop a blotchy rash from the heat of direct sun exposure. Their forearms, legs, neck and, perhaps, their face will break out but other parts will be spared. For the sake of comfort, these children must limit their time exposure in the heat and wear tightly woven, light weight, long sleeved and long legged clothing. Fair-skinned, freckled children should even wear a shirt when swimming.

Ophthalmologists are now warning us of the long term hazards of UV exposure to the eyes. Cataracts are increasingly found among sun worshippers. Sun glasses that filter out both UV-A and UV-B rays are recommended even for young children. Inexpensive but effective plastic sunglasses for children can be found in chain discount stores. Now if you can only convince the kids to wear them! Failing that, a hat with a broad rim is the next-best thing. At the beach, use both (be sure both items are on your packing list).

As in other aspects of life, timing is important. Avoidance of outdoor exposure from 10 a.m. to 2 p.m. when the sun's radiation is the strongest (and air quality is the poorest) is a wise strategy. Indoor games in a cool environment keep kids occupied. The lunch or snack break at this time often keeps children from early afternoon crankiness, as well. Cloudy weather lulls parents into the false impression that UV protection for skin and eyes is not needed. Ultraviolet light penetrates clouds. Use protection as if it were a sunny day. On the other hand, glass filters out UV. Stting next to a window on a sunny day may keep you warm, but you will not burn. (The warming infrared rays of the sun are not filtered out by glass.)

If your child is unfortunate enough to acquire sunburn, contact his or her pediatrician regarding the best method to promote healing. The method recommended will depend on the degree and surface area of the burn.

With proper preparation, your children can enjoy the outdoors as much as you did as a child. Educate them to take proper precautions so they can romp and play the way we wish we could!

All Rights Reserved 4/98 The Pediatric Group, P.A.

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.